Welcome to DR. STU'S BLOG. Along with my podcast at www.drstuspodcast.com it is here that I post my thoughts on a variety of topics on the birthing world. Advocacy for true informed consent and respect for individual autonomy are the basis for the musings you will read here. I hope you enjoy while you learn and I encourage you to comment. Please check out www.birthinginstincts.com for information on home birthing with an obstetrician and my latest news and updates.

"All that is necessary for the triumph of evil is for good men to do nothing" Edmund Burke, 18th century Philospher.

"A long habit of not thinking a thing wrong gives it a superficial appearance of it being right." Thomas Paine

"The welfare of humanity is always the alibi of tyrants." Albert Camus

"Choice is the essence of ethics: if there were no choice there would be no ethics, no good, no evil; good and evil have meaning only insofar as man is free to choose." Margaret Thatcher, March 14, 1977

“It is difficult to get a man to understand something, when his salary depends on his not understanding it.” ― Upton Sinclair

Explaining the Cause

I am a practicing obstetrician who is a strong supporter of patients rights to informed consent and refusal. I believe a patient has the right to choose her own path given true and not skewed informed consent. Following that tenet, just as a woman should be able to choose to have an elective c/section she should be able to choose not to have one, as well. The American system of hospital based obstetric practice has been eroding those choices for women for quite some time. Due to concerns of economics, expediency and fears of litigation women are being coerced to make choices that may not be in their best interest.

I have had a long relationship collaborating with midwives and find the midwifery model of care to be evidenced based and successful. I was well trained at Cedars-Sinai Medical Center in the mid 80's to perform breech deliveries, twin deliveries, operative vaginal deliveries and VBACs, and despite evidence supporting their continued value, hospitals are "banning" these options. Organized medicine is also doing its best to restrict the availability of access to midwives.

Home birthing is not for everyone but informed choice is. Medical ethics dictates that doctors have a responsibility and a fiduciary duty to their patients to provide true, not skewed, informed consent and to respect patient autonomy in decision making. Countries with the best outcomes in birthing have collaboration between doctors and midwives. This is not what has been happening in the hospitals of America. Its time for a change and the return of common sense.

The midwifery model of care supports pregnancy as a normal function of the female body and gives a legitimate and reasonable alternative to the over-medicalized model of birth that dominates our culture. Through this blog I hope to do my part to illuminate what is wrong with our maternity care system and what is right with it. I do not expect all to agree and that is OK. We must all understand that given honest data it is not always reasonable to expect two people to come to the same conclusion. Our differences should be respected.

Sunday, April 18, 2010

I was sent this link to an Australian Documentary being made about the possibility that home birthing may be outlawed there. We cannot stand idly by as these personal choices and birth rights are systematically attacked. Whether one agrees with home birthing or not, we should always allow for self determination when it comes to our bodies. There is an insidious and totalitarian trend that has been speading its tentacles into so many aspects of the liberty loving free world. I encourage you all to make your voices heard so that clarity on these issues spreads to the sleeping giant that is the freedom loving peoples of the world. Please demand that politics and lawyers stay out of your homes. For if we remain silent we will get what we deserve and what will be next. I am not surprised about much of anything anymore. But I remain pissed off!

Friday, April 16, 2010

Here is the speech I was to give at the Tea Party Tax Day Rally in Thousand Oaks, CA yesterday. I think it is better when I am speaking but wanted to share my thoughts, as usual. Warmest regards to all, Dr. F.

"A wise man, in a past time of wisdom, a patriot named Thomas Paine, author of the original “Common Sense”, was quoted to have said, “The long habit of not calling a thing wrong gives it the superficial impression of being right.” So it has been with American citizens not paying attention to their own government. Sadly, it has taken the passage of this monstrously corrupt health care bill to wake the sleeping giant that is American Values. It is time to stand up for our liberty and call what is happening just wrong.

I am so honored to speak here today. I have been asked to give a practicing doctor’s perspective on what is happening to our health care system. Now, despite what words may follow, I am very motivated to help fix what I consider to be a broken leftist ideology about health care as a right. For if it is a right then it implies that people have the right to my services for whatever value the current democratic leadership decide I am worth

“I observed that in all the discussions that preceded the enslavement of medicine. Men discussed everything—except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only ‘to serve’.”Ayn Rand, from Atlas Shrugged, 1957

Healthcare is not an inanimate commodity like oil or water. It is people!

What we will see as government and organizations and insurance companies begin to micromanage our lives are mandates based, not on evidence or the realization that each patient is an individual, but on ideological, nanny state one size fits all ideals that are determined by politically favored elites. Forcing behaviors upon us by any means possible is the fanatical religion of those on the secular left who are true believers in a society defined by what they think is best. You will begin to see laws and commercials and public service announcements, paid for by government stimulus money which entices you by reward or punishment to follow their advice. Advice based most often on emotion and not science. You will see more brainwashing type curriculum using your tax dollars in public schools with the purpose of indoctrinating our children early on towards the “correct” way to think. It is Orwellian and it is possible. No almost certain under this leftist administration.

You have seen it already. Crusades against second hand smoke (Have you seen the commercial about the little kid playing in the apartment building? C’mon, really?) or hetero-sexual aids or swine flu ( oops, where did those panics go?) and, now for Global Warming, excuse me, Climate Change and the need to go green no matter what the cost to our future generations.

The latest monkey business is legislation that will force restaurant chains to put the caloric content of their food on the menu. There is no evidence that this will do anything but increase costs to restaurant owners who will have to raise prices to us. In fact, there is evidence that exists that shows it will be pointless. But when you have a crusade and an ideology who cares about that little nuisance called facts. I submit that in the 20 years since we have been forced to put nutritional information on all grocery products Americans have gotten fatter, not thinner. I don’t go to a steakhouse because I care about caloric content. We need a congress that understands this and stays out of my pancakes!

Really, what we have now unleashed in our beloved country is a hostage situation to the American legal system. Whether it’s the local restauranteur, the small businessman, the ski resort, your family doctor or your local hospital or school we are all victimized by a lack of restraint on our legal tort system. Quite frankly, my biased opinion thinks that the biggest obstacle to American values returning is the American legal system. If any industry was in need of reform it is that one. Where are the future leaders who are willing to take on the trial lawyers? Now that would show real bravery. Dennis Prager and others have rightly labeled ObamaCare as, “The trial lawyers of America stimulus package”.

Recently, a midwife friendly hospital in Greenwich Village closed its doors due to its inability to stay financially solvent while trying to comply with all the mandates, regulations and legal protections required. The organization that runs residency training programs in the United States has predicted an increasing shortage of applicants in the next decade. Many doctors are already at the point where they cannot afford to continue to take on more patients for ever decreasing reimbursement. MediCal and medicare patients are going to find it harder to make appointments and are going to be waiting longer. The cost estimates in the ObamaCare bill are fictional. Everyone knows that or lives in denial. When costs cannot be contained there are only 3 choices. Raise taxes, lower reimbursement or ration care. Raising taxes will not solve anything as the well will run dry. And lowering reimbursement further will just push doctors and hospitals out of business, as it has in Greenwich Village and lead to rationing by default. This health care bill is unsustainable and un-American. Most doctors love our profession but hate what the business of medicine has become.

As for my practice: Carolyn asks whether I would consider giving it up and retiring early. The answer is really, can I afford to keep going? Is it worth it. Take the man who owns a horse. He adores that animal and derives much joy from riding and caring for it. But he can no longer afford to feed it. He cannot bring himself to sell it so he decides he will save money by cutting back each day on the amount of hay he feeds the horse. Each day he will feed it a little less and in that way save money. Finally, he reaches the day where he no longer has to feed the horse. He arrives for his joyful ride only to find the horse dead! What a shocker. (Horse and Hay story of Tim Conway Jr. from KFI Radio). Such is the analogy for this health care entitlement.

I have spoken about this many times before. Not only will doctors able to quit consider doing so but who in their right mind will become the future doctors in our country. Years of training, and sacrifice of social life. Loss of a decade of fun and earning power. Massive debt. Only to come out and see your expenses rising and uncontrolled but your earning power capped and regulated. The devastating threat of a career ending law suit hanging over your head like the sword of Damocles is no way to live. Having authorization for a test or procedure denied by some non-medically trained faceless cubicle worker who can’t even spell the diagnosis is maddening. Your decisions weighed and scrutinized by utilization review boards, government agencies and hospital committees. None of whom will ever bother to get to know the patient you are advocating for. How many of you would want to live like this? Would want your children to choose this?

And to this point I haven’t even mentioned the looming specter of Electronic Medical Records coming by 2014. Every detail of your medical history, and that of your children will be mandated to be online for bean counters of all shapes and motivations to peruse. Do you trust that it will remain confidential? I don’t! And there will be an amazing cost of installing the hardware, software and annual updates that will not be reimbursable to the practitioner. Adding another undo burden on the small, independent practice of doctor, midwife, chiropractor and therapist. Another not so subtle hammer to force doctors like me out of business or submit to joining large multispecialty impersonal groups run by large conglomerates or government agencies where the individuality and art of medicine I love will disappear.

Politics and politicians have no business invading the doctor patient relationship. The system is rotten to the core. We all saw this openly in the dirty tactics, special interests and bribery of all too eager politicians in the passing of Obamacare. People ask me why the AMA supported the bill. First, this may come as a surprise but less than 17% of America’s doctors belong to the AMA. And almost all of those are in academia, residency or retirement. Actually, I do not know any colleague who is a member. So the AMA does not represent the practicing doctor. The AMA represents the AMA. They do not care about you. They do not care about me. They do not really care about health care. They have a financial interest in this legislation just as does the AARP. They have made a deal with the devil, in my opinion. We have become a nation of deception by large special interests. The propagandists never say what they really mean.

Which brings me to the General Electric corporation, run by Jeffrey Immelt, one of president Obama’s biggest supporters and White House visitors. GE is apparently in line to be the major player in the EMR technology. Some say a 7 billion dollar deal. That’s our tax money, by the way! Numbers that are too big to really grasp. But here is an interesting tidbit. I was talking with a group of health care professionals about the legislation recently. Someone brought up an odd provision in the bill that increased payment to doctors for bone density studies. We all thought it odd that a bill that has few specifics would single out one procedure for increased reimbursement. How odd that in a 2700 page bill that this one test would be mentioned specifically! Well, here is my logical, yet cynical conclusion. With bone density payments diminishing over the last 5 years no one is buying bone density machines because it does not pay to own one. If reimbursement goes up, it may make sense for medical groups to purchase new machines again. Well, guess who is the leading manufacturer of bone density machines? Yep, General Electric.

So, we have come to a place where we have to decide who we trust. No longer can we be passive when it comes to something as important as health care. We have to take a stand. I trust the relationship I have with my personal physician. I trust my ability to judge him by his actions. I trust that he has my welfare as his primary concern. I trust that if he does not serve me well I can go someplace else. I do not trust big government or big business to have my back. I do not trust the nanny state to make decisions in my family’s best interest. I will do that and I want a country that allows me the freedom to succeed or fail. One size does not fit all. The government should not have the right to take my hard earned skills and demand of me to give them away for what they determine they are worth. I have never dreamed I would be before you all today making emotional speeches. All I wanted to do was to practice my profession as I was trained to do and love my family. But, I cannot sit idly by and watch this happen. I want my children to know that their dad stood up for self determination and personal responsibility.

I would close with this quote from Ayn Rand’s Atlas Shrugged. ““Let them discover the kind of doctors their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it—and still less safe if he is the sort who doesn’t.” Ayn Rand, from Atlas Shrugged, 1957

The best and the brightest should be going into noble professions like medicine. Sadly, unless we elect leaders who pledge to repeal this horrible health care legislation, medicine will no longer be noble and the best and brightest will seek other interests. Possibly becoming lawyers or government workers because that’s where the money and lifestyle remain.

Thank you for allowing me to vent and for your passion and love of country."

Sunday, April 11, 2010

Very telling of the times we live in that a simple normal vaginal birth makes the news in Canada. But, still, its a turn toward common sense and evidenced based medicine and that should never be taken lightly. Congrats to the family and health care practitioners on this happy event. Dr. F

Saturday, April 10, 2010

Here is an article sent to me by Laurel Phillips in Santa Barbara from today's NY Times. Another sad example of the loss of our inalienable rights due to economic forces and fears of litigation. Is this the Health Care Reform we desire? And "Tort reform is off the table" says our President and Congress.

We cannot feel despair. For me, this sort of story motivates me even more to take positive action. Reinforcing my belief that normal birth needs to be taken out of the hospital model. Market forces would support free standing women's health and maternity centers. There are enough midwives and supportive doctors around to make this a reality. What is needed are motivated patients and funding. Keep spreading the dream and the right circumstances will fall in to place.

Amy Tinney and I are working with some leads and putting a business plan in place for a Los Angeles site. Any support or expertise in this realm would be welcome. Thanks, Dr. F

N.Y. / REGION | April 10, 2010 Big City: With the Closing of a Hospital, Women's Childbirth Options Diminish By SUSAN DOMINUS Mothers-to-be will lose a midwife-friendly alternative after a decision by the board of St. Vincent's Medical Centers to close its flagship hospital in Greenwich Village.

Subscribe To Support Dr. Fischbein

Many Voices!

Dear friends, You must know by now that one third of all women in this country are now delivering their babies by cesarean section. This is an amazing statistic when compared to the rest of the world and has to imply that many women are being deprived of choice and having unnecessary surgery often without their full informed consent. I have a teenage daughter. What will the future hold for her and all the future mothers in our country? The current obstetric environment does not bode well for these women and we have yet to experience the full knowledge of the physical and emotional damage being done by all these surgical births. For our beloved daughters and for the sake of all our future mothers the time to stand down is over. Make your voices heard. Thank you so much, Dr. Stu